The Radiation Oncology and Surgery Branches of the National Cancer Institute have been involved in prospecitve randomized trials evaluating the potential role of intraoperative radiotherapy in three major disease sites including resectable and unresectable carcinomas of the pancreas, resectable carcinomas of the stomach and resectable retroperitoneal sarcomas. We have also been involved in a single arm pilot trial involved in dose escalation of intraoperative therapy in selected patients whose locally advanced tumors are felt unlikely to be cured by standard therapy and at least there is a theoretical advantage for the use of intraoperative radiation therapy. In January 1985, we began a pilot trial of combining surgery and intraoperative radiotherapy for locally advanced lung carcinoma. To date, 96 patients have been treated with experimental intracoperative radiation therapy on these various protocols and thera are an additional 59 other patients being followed as control patients on the various randomized prospective trials. We have clearly demonstrated that it is technically possible to combine intraoperative radiation theapy with a radical surgical procedure and that the acute morbidity from the combinations quite acceptable. To date, there does not appear to be any significant difference in the randomized prospective trials with respoect to a local control, disease free survival, and overall survival. Obviously, these trials are ongoing and require more patients and further follow-up. Patients also need to be followed for any potential late effects of intraoperative radiation therapy.